Eye Care Practices Research Articles

Implementation of Teleretinal Screening Using Optical Coherence Tomography in the Veterans Health Administration.

Background: The Veterans Health Administration (VHA) has an existing teleretinal screening program that uses nonmydriatic fundus photography to screen for diabetic retinopathy in primary care clinics. Concurrently, optical coherence tomography (OCT) has become a routine screening modality in eye clinics for the diagnosis and management of retinal diseases. Introduction: This study aimed to evaluate the first year of a pilot tele-OCT program that used existing resources within the VHA. Without the tele-OCT program, all patients would have been referred to retina clinic for an in-person evaluation. Materials and Methods: This is a retrospective chart review study of patients evaluated by a retina specialist through asynchronous tele-OCT evaluation in 2019. Electronic medical records were used to assess patients' demographic and clinical characteristics, tele-OCT consult results, and patient adherence to tele-OCT follow-up plans. Results: There were 158 tele-OCT consults originating from optometry and nonretinal ophthalmology clinics in 2019. After tele-OCT evaluation, 113 (71.5%) patients were recommended to be monitored in their originating eye clinic, 27 (17.1%) were referred to intravitreal injection clinic, and 12 (7.6%) were referred to retina clinic for in-person evaluation. Patient adherence to tele-OCT follow-up plans was 76.4%. Patients with decreased central vision (p = 0.007) and patients referred to intravitreal injection clinic (p = 0.043) were most adherent to follow-up. Discussion: The tele-OCT program reduced unnecessary in-person clinic visits and enabled more retina clinic availability. Follow-up adherence was greatest among symptomatic patients and those requiring treatment. Conclusions: Tele-OCT can extend tertiary care resources and improve patient care in a large multidisciplinary eye care practice.

Health and well-being in eye care practice: Negotiating with your patient's ocular health and well-being

Health care is under greater pressure than ever before, Neil Retallic and Sheena Shah ask the question… as eye care professionals how can we gain concurrence from our patients to follow our professional advice regarding their ocular and mental health?.

Long-Term Outcomes of Selective Laser Trabeculoplasty for Open-Angle Glaucoma in the Caribbean

To characterize long-term clinical outcomes of monotherapy selective laser trabeculoplasty (SLT) in Afro-Caribbean patients with open-angle glaucoma (OAG). This was a post hoc analysis of nearly 8 years (median, 3.2; interquartile range, 2.1-7.1) of pooled data from the West Indies Glaucoma Laser Study and its preliminary study. Setting: Three eye care practices in Saint Lucia and Dominica. Afro-Caribbean adults with mild-moderate OAG treated with ≤2 medications (61 in preliminary study, 72 in West Indies Glaucoma Laser Study). Participants underwent medication washout, baseline intraocular pressure (IOP) determination, and bilateral 360-degree SLT. Participants were followed for up to 94 months. Repeat SLT was performed according to prespecified criteria. The primary outcome was mean IOP reduction from baseline. The secondary outcome was medication-free survival with SLT repeated as needed. The pooled data set included 265 eyes of 133 Afro-Caribbean participants. The mean (standard deviation) baseline IOP was 21.2 (3.4) and 21.2 (3.9) mmHg in right and left eyes, respectively. Over 8 years, the mean IOP ranged from 12.8 to 15.7 mm Hg and from 13.1 to 15.8 mm Hg, respectively (P < .0001 for every comparison with baseline). The median medication-free survival time for initial SLT was 85.4 months in both eyes. The 94-month medication-free survival of SLT repeated as needed was 71.2% and 71.7%, respectively. Monotherapy SLT, repeated as needed, safely provides significant IOP reductions in most Afro-Caribbean adults with primary OAG through nearly 8 years of follow-up and has significant potential to delay or prevent glaucoma-related vision loss in black patients in low-resource regions.

Eye care in the community 6: Klinefelter syndrome

Continuing our series of challenging cases from the community eye care practice, Kirit Patel looks at a condition caused by an extra X chromosome

Visual Outcomes and Complications After Lensectomy for Traumatic Cataract in Children

The Pediatric Eye Disease Investigator Group Cataract Registry provides a multicenter assessment of visual outcomes and complications after lensectomy for traumatic pediatric cataract. To report visual acuity (VA) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months after lensectomy for traumatic cataract among children younger than 13 years at the time of surgery. From June 18, 2012, to July 8, 2015, 1266 eyes of 994 children from 33 pediatric eye care practices seen within 45 days after lensectomy were enrolled in a multicenter, prospective observational registry. Of these, 74 eyes of 72 participants undergoing lensectomy for traumatic cataract were included in a cohort study. Follow-up was completed by November 2, 2015, and data were analyzed from March 20, 2018, to July 7, 2020. Lensectomy after ocular trauma. Best-corrected VA from 9 to 15 months after lensectomy for traumatic cataract (for those 3 years or older) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months. Of 994 participants in the registry, 84 (8%) had traumatic cataract. The median age at lensectomy for 72 participants examined within 15 months after surgery was 7.3 (range, 0.1-12.6) years; 46 (64%) were boys. An intraocular lens was placed in 57 of 74 eyes (77%). In children 3 years or older at outcome, the median best-corrected VA was 20/250 (range, 20/20 to worse than 20/800) in 6 eyes with aphakia and 20/63 (range, 20/20 to 20/200) in 26 eyes with pseudophakia. Postoperative visual axis opacification was reported in 18 of 27 eyes with pseudophakia without primary posterior capsulotomy (15-month cumulative proportion, 77%; 95% CI, 58%-92%). The cumulative proportion with strabismus was 43% (95% CI, 31%-58%) in 64 participants with ocular alignment data; exotropia was present in 14 of 23 participants (61%). The cumulative proportion with glaucoma was 6% (95% CI, 2%-16%). Trauma was not a common cause of pediatric cataract requiring surgery. For children with traumatic cataract, substantial ocular morbidity including permanent vision loss was found, and long-term eye and vision monitoring are needed for glaucoma, strabismus, and capsular opacification.

Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework.

Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery. PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling. The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.

Health and well-being in eye care practice: Making the difference in your patient's life

Neil Retallic and Sheena Shah ask the question ‘Should we as ECPs be doing more to understand the well-being of our patients?’.

Eyecare practices and glaucoma patient care trends in the face of a global pandemic, COVID-19

Objective: To understand the effects of the COVID-19 pandemic on glaucoma eyecare practices and patient care trends. Design: Cross-sectional Participants: Comprehensive and glaucoma trained ophthalmologists Method: This was an internet-based statewide survey distributed to comprehensive and glaucoma-trained ophthalmologists in California. The survey consisted of 10 questions designed to address the effect of the pandemic on the volume of patient care visits, laser utilization, teleophthalmology trends, and frequency of routine, urgent and emergent glaucoma surgical procedures, among others. Main outcome measure: Not-applicable Results: Most ophthalmologists reported decreased patient volume as they focused primarily on seeing urgent and emergent glaucoma cases. While most respondents noted a significant decrease in routine surgical procedures, a majority reported a similar volume of urgent and emergent procedures comparable to the pre-COVID-19 era. Notably, most ophthalmologists responded that they did not change their prescription filling habits during the pandemic. Selective laser trabeculoplasty (SLT) utilization decreased, paralleling the reported decrease in patient volume. Finally, just over half of the ophthalmologists surveyed implemented teleophthalmology into their practice. Conclusion: Discovering patient care trends shed light on areas of needed advancement, such as teleophthalmology, and provides necessary insight into how ophthalmologists are coping with the challenges brought on by the pandemic.

Neonatal care practiced by the mothers in Muslim-communities in Birgunj Metropolitan city, Parsa, Nepal

Neonatal period is the most vulnerable period of the survival of the child, so good neonatal care practices is crucial for the prevention of morbidity and mortality of a neonate. Descriptive cross-sectional study design with 219 Muslim women having less than 1year old babies were selected by probability sampling technique to find out the neonatal care practices. A semi-structured interview schedule was used for data collection. Data were analyzed using descriptive and inferential statistics. Early marriage and illiteracy is common in these Muslim communities. Only around half (49.8%) of mothers had sufficient neonatal care practice. However, there is good eye care practice in those communities. All of the mothers practiced oil massage to their babies once or more than one time in a day. Regarding breastfeeding, more than four fifth (83.87%) of mothers fed exclusively to their newborn; 13.24% mothers had home deliveries, among them 75.85% of deliveries were assisted by unskilled personnel. The significant association was found between level of neonatal care practice and age of mother (p-value 0.024). Likewise, mother’s education is also associated with the feeding of colostrum (p-value 0.038). Insufficient neonatal care practiced was predominant among mothers of those Muslim communities so there is need for strengthening community awareness by mobilizing female community health volunteers (FCHVs). Home delivery by unskilled personnel is very common so they should be motivated for institutional delivery and completion of the recommended antenatal visits.

Eye care in the community: Blunt trauma injury to the eye

In anticipation of a new series of challenging cases from eye care practice, community-based optometrist Kirit Patel describes traumatic injury and its assessment and management during the current Covid-19 pandemic

BYNOCS®1 – A Cloud-Based Indigenous Tele-Health Vision Therapy Software for the Assessment and Management of Binocular Vision Disorders

Background: Binocular vision assessment is an integral part of an eye and vision care practice. With the need for a user friendly, simplified, and comprehensive tool especially in this digital era, we propose a new indigenous cloudbased software, Bynocs.® This manuscript describes the technical details, the functioning of this indigenous software, and a case series demonstrating the application and efficacy of Bynocs® as a tele-health vision therapy tool. All the three cases were handled remotely through the Bynocs tele-health vision therapy platform. Case Reports: Case 1: This is a case of symptomatic convergence insufficiency who had prior compliance issues with a conventional vision therapy approach. With 10 sessions of Bynocs vision therapy focused on improving convergence amplitudes, the patient showed significant improvements in both subjective and objective parameters. Case 2: This case is of a 12 year old child with residual anisometropic amblyopia who had excellent compliance with patching therapy for 3 years but visual acuity had plateaued over the last 6 months. After 20 sessions of Dichoptic amblyopia therapy, best-corrected visual acuity (BCVA) improved by 3 log MAR lines, with improvements in stereoacuity to 100 sec of arc. Case 3: This case of a 10 year old child with residual exophoria after strabismus surgery was referred for managing the residual deviation and associated visual complaints. The child had 20/20 visual acuity in both eyes and 10 prism diopters of residual exophoria at distance and near. After 30 sessions of vision therapy, improvements in fusional vergence amplitudes was achieved along with the deviation restoring to orthophoria at both distance and near, with further improvements in stereoacuity from 400 sec of arc to 120 sec of arc. Conclusions: As tele-health is finding favor across the globe, Bynocs® can be a valuable tele-health vision therapy tool for in the management of binocular vision anomalies and amblyopia with the functionality for remote diagnosis and therapy.

Migraine Screening in Primary Eye Care Practice: Current Behaviors and the Impact of Clinician Education.

Migraine is underdiagnosed and undertreated. Optometrists are primary eye care providers, who regularly encounter people with migraine as an incidental finding during routine eye examinations, or when patients present to rule out whether visual or ocular problems are contributing to headache symptoms. Knowledge and use of a migraine screening tool in optometric practice is, therefore, important to be able to identify and refer people with migraine for appropriate management. We sought to investigate optometrists' current behaviors regarding screening for migraine, and to assess the effectiveness of an educational resource in promoting the use of a 3-item validated migraine screening questionnaire, the ID-Migraine. We first conducted a cross-sectional study using a survey to assess optometrists' current knowledge and behaviors about migraine screening and willingness to participate in a pilot implementation program. Participants who provided their contact details were invited to watch an online educational resource about a validated migraine screening tool. After 6 weeks, these participants were invited to participate in a follow-up cohort study involving a survey to assess the effectiveness of the educational resource. Ninety-eight optometrists completed the initial survey as part of the cross-sectional study. We found that most optometrists actively asked patients about migraine (79/98 respondents, 81%) as part of routine eye examinations and self-rated themselves as confident in identifying migraine (71/98 respondents, 72%). However, the majority (90/98 respondents, 92%) were not aware of any validated migraine screening tools. Seventy-eight respondents provided their contact details to receive information about the subsequent cohort study. In response to the follow-up study survey (31/78 participants, 40%), 45% (14/31 respondents) of participants self-reported using the ID-Migraine tool after watching our educational video, and most of these participants (12/14 respondents, 86%) were likely or extremely likely to continue to use the tool in their practice. From our initial cross-sectional survey, we conclude that optometrists do not currently use validated screening tools for migraine and as such, there is an opportunity for continuing professional development in this area. Our follow-up cohort study demonstrates that educating optometrists on the importance and utility of a validated migraine screening tool is achievable with a relatively simple, low-time investment intervention (an online educational video). Such education may result in improved identification of migraine, which may lead to improved management.

Insights Into Eye Care Practice During COVID-19

Practice Patterns and Responsiveness to Common Ocular Complaints Among US Ophthalmology Centers During COVID-19

Covid: Keeping you updated 19

This week has seen some Covid-related developments of particular interest to eye care practice. Bill Harvey offers some details

Systemic side effects of ocular medication: Diagnostic drugs – part 1

To complement her recent series on systemic drugs, Dr Doina Gherghel looks at the adverse effects of ophthalmic drugs. This first article focuses on those drugs used in eye care practice for assessment and diagnosis.

Use of Remote Optometric Vision Therapy in a Primary Eye Care Practice

Many optometrists supplement office-based vision therapy with home-based vision therapy procedures. Others prescribe primarily home-based vision therapy activities with in-office instruction. With recent development of telehealth online platforms, it is possible to enhance home-based vision therapy with one-on-one doctor-guided and vision therapist-guided remote optometric vision therapy (ROVT). This may increase access for times when the patient is not able to present to the office. Procedures for implementing ROVT are discussed including patient selection, case management, and technical requirements. 35 patients received ROVT, with the vast majority responding positively. Three cases of ROVT are presented. While there are significant limitations to ROVT, this experience shows that it is possible to conduct ROVT when there is need. We found that case selection and parental support at home are important factors for success.

Attitudes and Practices in the Prevention of Purulent Ophthalmia Neonatal in Senegalese Hospital

Introduction: Ophthalmia or neonatal conjunctivitis is a major public health problem in developing countries. Recommendations have been issued by the World Health Organization (WHO) and the Ministry of Health of Senegal for the prevention of this scourge. The objective of the work was to assess the level of knowledge and practice of these recommendations by health workers. Methodology: This was a multicenter, prospective study conducted from March 1st to June 30th, 2013 in nine (9) health structures at the four (4) districts of Dakar. All agents who performed care at birth were included. Results: We interviewed 108 health care workers in the nine targeted structures. More than half of the respondents (54.6%) interviewed were in a maternity ward with midwives (41.7%) who were clearly in the majority. As far as knowledge is concerned, the practice of neonatal eye care was systematic for 88% of the nursing staff at birth. Regarding attitudes and practices, the majority of caregivers cleaned (67.6%) the eyes before instillation of eye drops. More than eighty-four percent (84.3%) of the caregivers surveyed routinely practiced eye care in the newborn at birth. The majority of the agents prescribed Rifamycin (47.2%) as a single dose in each eye. Paediatricians recommended one day of treatment while midwives and general practitioners recommended 7 days. Conclusion: Overall, the recommendations are not well implemented by caregivers. It would then be necessary to improve the level of information for harmonization and application of the recommendations.

How to run an efficient eye care practice during and after the COVID-19 pandemic

Introduction : The COVID-19 pandemic is the defining global health crisis of our time and one of the the greatest challenges the world has faced. During the pandemic there have been significant changes in the healthcare systems, especially in the access to local eye care. That is why it is essential for any eye care practitioner to adopt the proper measures in order to run a successful and efficient eye care practice during and after the COVID-19 pandemic. Aim: The purpose of this article is to share expertise on successful re-opening of eye care practice after the peak of the COVID-19 pandemic, providing best protection for the patients , practitioners and support staff. Materials and Methods: Analysis of the possible safety measures and their implementation during the challenging period of re-establishing standard eye care practice after pandemic peak has been conducted. Results: A clear guidelines regarding organization, policy and leadership are provided after their pilot testing. Special solutions include: environment, attire, behavior, media (web-based behavior), communication with patients, how to manage new patients, what to change for better experience and how to improve leadership during the pandemic situation. Conclusion: Taking proper care for each patient and team member during the difficult times of a pandemic is an investment in the future. An eye care practitioner and practice manager must always be informed, flexible and adaptable, especially in challenging situations such as a pandemic.

Fundamentals of eye care practice 3

Tina Arbon Black and Peter Black describe the key professional bodies, regulators, and representative organisations that offer guidance, support and education or set legal frameworks within which eye care professionals practise.

Association between knowledge, awareness, and practice of patients with type 2 diabetes with socio-economic status, adherence to medication and disease complications

AimsDiabetes is a self-managed condition; knowledge, attitudes, and practices about the condition can influence the overall treatment outcomes and complications of the disease. The aim of this study was to assess the knowledge, attitude, and practice toward diabetes among T2DM patients in the UAE, a highly prevalent country with diabetes. MethodsWe used the revised Michigan Diabetes Knowledge Scale on T2DM patients. The awareness on diabetes was then assessed based on socio-demographic characteristics, illness perceptions, medication adherence, diabetic self-care, and T2DM complications. ResultsOverall assessment of T2DM patients on their knowledge, and attitude toward their diabetes were good in the majority of participants (544, 76%; 570, 76% respectively). However, adherence to diabetic self-care practices was fair in the mainstream (437, 57%). The compliance to medication (527, 70%) and eye care practice (475, 63%), were quite high; yet regular checking blood sugar at home 330 (44%) and the foot care practice 336 (45%) were not satisfying. ConclusionOur results demonstrate that the intensive education service being given and time the physician spends with the T2DM patients is highly associated with better practice and outcome of the disease. There is a need for the establishment of better DM education programs in PHC clinics and the development of more campaigns and enlightening programs, both for health care providers and public on T2DM self-care, complications, and nature of the disease. We suggest that new policies be established with a focus on increasing community awareness of diabetes and preventive measures in UAE.